Week three of our Falls Awareness September blogs by
Rebekah Wilson. Ayrshire and Arran Falls Lead
Last week I took part in a session and experienced the ‘aging suit’. The age simulation suit offers the opportunity to experience the impairments that may be faced by older people. My vision and hearing were restricted as were the movements of my joints, my grip strength and coordination. Once suited up I was set some usual daily tasks – pouring a glass of water, writing a shopping list and finding and folding some items in the room. I managed my chores but with a real challenge and what struck me most as I reflected on the session was how properly frightened I had been of falling.
Not surprisingly, many people who have a fall develop a fear of falling again, becoming more cautious, stopping doing things and losing confidence in abilities. However it is also very common for people to worry about falling even if they have not had a fall and it is believed that it is experienced by up to half of older people living in the community. Having fears about falling is often distressing, limiting life in so many ways it can become a serious concern. Constantly worrying about falling can prevent us from having an active and fulfilling life.
Being frightened of falling is such a challenge to those who are feeling the fear and to those who are caring for frightened people. How can we help people who have a fear of falling?
It would seem that a good place to start is to talk about it! It is so important to have someone listen to your fears and acknowledge them. Recognising and understanding the existence of fear of falling and the extent it can impact on everyday function is a positive step to addressing the fear. The trauma of someone who has had a long lie following a fall cannot be overlooked when providing interventions for the recovery of the physical injury from the fall. Yet in making recommendations and providing interventions to the person and their family and carers, I am increasingly aware and mindful of how my approach can reinforce risk aversion and fear. As Ann Murray, National Falls Programme Manager mentioned ‘overemphasising risks and focusing only on safety may inadvertently stigmatise falls or cause people to restrict their activities’.
It’s a cycle seen all too often. It starts with a fall, then inactivity, then weakness and finally greater risk for falling and injury. Although appropriate caution is healthy, avoiding too many activities puts you at risk. The more worried you become of falling the less likely you are to keep active and restrict activities unnecessarily due to reduced confidence.
Since physical capacity declines with age, keeping active is an important way to reduce the impact of this inevitable decline. Fearful individuals often slow their walking, widen their stance, and make other adjustments that badly affect their balance.
Anxiety can make you act in ways that help you feel safer – for example, holding onto things because you think you will fall and for many people this then results in not going out anymore. Avoiding or stopping doing things can make life difficult and most certainly less enjoyable.
What strategies can help?
The good news is that it is possible to break the fear of falling cycle. People all have different attitudes and levels of tolerance to risk and I believe that AHP’s have a valuable role in working with individuals, caregivers, family and friends to achieve a balance of risk and activity.
Limiting activity won’t prevent falls but taking the opportunity for falls prevention and management will prevent falls.
Multifactoral falls risk screening can identify falls-related risks factors that can be treated, modified or better managed. Following a falls risk screen and then providing individuals with an action plan provides some ‘self-defence’ strategies and gives a measure of control in lowering risk for falling and falling injuries. Reducing fear can contribute to maximising an individual’s capacity and control over life and has the potential to impact positively on preventing further ill health.
There are things we can suggest to support people to reduce their fear of falling.
Stay active and make use of local supports available
Set small goals to help restore confidence
Where possible get active out of the house as well as remaining active in your own home.
Continue with favourite hobbies or take up new ones
Get involved with local community clubs or groups
Think about the times you have not fallen.
Think about your progress.
Tell yourself how well you are doing.
Try to think positively.
Enjoy the present.
Keep your sense of humour!
Look after yourself
Eat healthily, get enough sleep and exercise regularly to help stay healthy and active.
Learn to pace yourself.
Allow time for yourself each day.
Practice relaxation exercises.